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7. Brox JI 2003 ; Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises for the postlaminectomy syndrome. Ann Rheum Dis, Suppl 1 229 ; . 8. Brox JI, Sorensen R, Friis A, Nygaard O, Indahl A, Keller A, Ingebrigtsen T, Eriksen HR, Holm I, Koller AK, Riise R, Reikeras O 2003 ; Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine, 28 17 ; : 1913-21. 9. Burkus JK, Gornet MF, Dickman CA, Zdeblick TA 2002a ; Anterior lumbar interbody fusion using rhBMP-2 with tapered interbody cages. J Spinal Disord Tech, 15 5 ; : 337-49. 10. Burkus JK, Transfeldt EE, Kitchel SH, Watkins RG, Balderston RA 2002b ; Clinical and radiographic outcomes of anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2. Spine, 27 21 ; : 2396-408. 11. Christensen BF, Hansen SE, Laursen M, Thomsen K, Bunger CE 2002a ; Longterm functional outcome of pedicle screw instrumentation as a support for posterolateral spinal fusion: randomized clinical study with a 5-year follow-up. Spine, 27 12 ; : 1269-77. 12. Christensen FB, Hansen ES, Eiskjaer SP, Hoy K, Helmig P, Neumann P, Niedermann B, Bunger CE 2002b ; Circumferential lumbar spinal fusion with Brantigan cage versus posterolateral fusion with titanium Cotrel-Dubousset instrumentation: a prospective, randomized clinical study of 146 patients. Spine, 27 23 ; : 2674-83. 13. de Kleuver M, Oner FC, Jacobs WC 2003 ; Total disc replacement for chronic low back pain: background and a systematic review of the literature. Eur Spine J, 12 2 ; : 108-16. 14. Delamarter RB, Fribourg DM, Kanim LE, Bae H 2003 ; ProDisc artificial total lumbar disc replacement: introduction and early results from the United States clinical trial. Spine, 28 20 ; : S167-75. 15. Fairbank JC, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R 2005 ; Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ, 330: doi: 10.1136 bmj.38441.620417.BF published 23 May 2005 ; . 16. Fritzell P, Hagg O, Jonsson D, Nordwall A 2004 ; Cost-effectiveness of lumbar fusion and nonsurgical treatment for chronic low back pain in the Swedish Lumbar Spine Study: a multicenter, randomized, controlled trial from the Swedish Lumbar Spine Study Group. Spine, 29 4 ; : 421-34; discussion Z3. 17. Fritzell P, Hagg O, Nordwall A 2003 ; Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group. Eur Spine J, 12 2 ; : 178-89. 18. Fritzell P, Hagg O, Wessberg P, Nordwall A 2001 ; 2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine, 26 23 ; : 2521-32; discussion 32-4. 19. Fritzell P, Hagg O, Wessberg P, Nordwall A 2002 ; Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine, 27 11 ; : 113141. 20. Geisler FH, Blumenthal SL, Guyer RD, McAfee PC, Regan JJ, Johnson JP, Mullin B 2004 ; Neurological complications of lumbar artificial disc replacement and comparison of clinical results with those related to lumbar arthrodesis in the literature: results of a multicenter, prospective, randomized investigational device exemption study of Charite intervertebral disc. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine, 1 2 ; : 143-54.

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Fig 5. Southem blot analysis of HTLV-I proviral integration in Psf Iand EcoRl digests of DNA obtained from patient no. 5. A ; There are three Pst I restriction sites within the complete HTLV-I genome that on digestion yield three bands of 1.2.1.8. and 2.5 Kb in the presence of both polyclonally and monoclonally integrated HTLV-I. In patients with monoclonal viral integration, there are one or two additional bands that are encompassed by one Pst I site within HTLV-I and another in host DNA adjacent to the virus. In patient no. 5 before therapy center lane A ; the three Pst I restriction bands present in the complete viral genome were not evident; rather, t w o other bands of 3.8 and 3.2 Kb were present. This pattern is the hallmark of an aberrant form of HTLV-I that is clonally integrated into the leukemic cell DNA. No HTLV-I was demonstrable in the Pst Idigests of the DNA of circulating cells obtained on day 459 following initiation of therapy, supporting the view that this patient was in a complete remission. B ; There are no EcoRl restriction sites within the HTLV-I genome. Therefore the generation of bands representing restriction-lengthfragments containing HTLV-I depends on the recognition of EcoRl sites in host DNA adjacent to viral integration. Clonal integration of the complete virus is indicated by a band in EcoRl digest that is larger than 9 Kb, the size of a viral genome. In patient no. 5 before therapy, a single band of 8.6 Kb was demonstrable on EcoRl digests of mononuclear cell DNA. The presence of a band is in accord with monoclonalviral integration into the leukemic DNA of the patient. Furthermore, this pattem with a band smaller than 9 Kb confirms that the integrated HTLV-I is abnormal and manifests a deletion within the HTLV-I genome. This band was no longer evident on EcoRl digests obtained during remission day 459 ; . A schematic diagram of the virus showing Pst I and EcoRl restriction endonuclease sites is shown below.
Different culture flasks performed according to the procedure outlined above showed that the mucopolysaccharide composi tion of both the cells and the secretory material was reproducible. Since the culture was maintained only for a limited period of time, it is not known whether the synthetic pattern remains stable through repeated subcultures. For determination of whether, in addition to the sulfated among the sulfated mucopolysaccharides found inside the cells synovial sarcoma cells also synthesize of fibroblastic type; the properties of this fraction that have mucopolysaccharides, hyaluronic acid, electrophoretic analysis on cellulose acetate been investigated so far e.g., resistance to chondroitinase extracts was perABC, lability of sulfate groups ; suggest that it may be a of the 35S-labeled mucopolysaccharide 878 CANCER RESEARCH VOL. 33.

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Announcement Sign Up for Alerts--It's Free! Archives of Neurology offers the ability to automatically receive the table of contents of ARCHIVES when it is published online. This also allows you to link to individual articles and view the abstract. It makes keeping up-to-date even easier! Go to : pubs.ama-assn misc alerts.dtl to sign up for this free service.

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O. Lpez-Jodra et al. Table II. Agreement and differences % ; between the colorimetric and reference microdilution methods for five antifungal drugs: amphotericin B, fluconazole, itraconazole, ketoconazole and 5-flucytosine against C. neoformans isolates Dilutions 3 2 1 agreement difference agreement difference agreement difference agreement difference Amphotericin B 92.683 7.3171 Fluconazole 92.5 7.5 80 Itraconazole 85.366 14.634 70.732 Ketoconazole 100 0 95.12 4.878 75.61 and anaprox Relationship with certain symptoms of ADHD Barkley, 1997 ; . Kidd 2000 ; stated that food additives, intolerance to foods, sensitivities to environmental chemicals, and exposure to heavy metals can be related to the development of ADHD in some cases. Researchers have found that children with ADHD may have an increased sensitivity to simple sugars, which may contribute to some of their symptoms Browne & Sutton, 1995 ; . Particular nutritional substances may also have some benefit in treating the symptoms of ADHD Dykman & Dykman, 1998 ; . A final example is evidence correlating previous head injury with the development of ADHD symptoms Herskovits, Megalooikonomou, Davatzikos, Chen, & Bryan, 1999 ; . Psychosocial factors that have been implicated in the development of ADHD symptoms include marital distress, family dysfunctions, and low socioeconomic class Faraone & Biederman, 1998; Fischer, 1990; Swallow, 1998 ; . Because most of this research centers on the effects of psychosocial stress on biochemical and neurophysiological functions, this will be addressed in a separate section. Finally, the role of temperament is significant. Most researchers currently view temperament as having a strong genetic basis but capable of being modified through one's lived experiences Hallahan & Kauffman, 2000 ; . Some evidence also exists for correlation between different temperaments and ADHD. The strongest evidence comes from such research as Thomas and Chess's 1984; see also Kazdin, 1997 ; investigations indicating correlation between different temperaments and the predisposition to develop emotional or behavioral disorders. A one-to-one relationship between temperament and disorders, however, has yet to be identified. Researchers such as Peled, Carraso, Globman, & Yehuda 1997 ; have moved closer to such identifications. These authors have described three behavioral styles of people with ADHD symptoms. Individual differences are also evident when one considers the presence of comorbid factors in those with ADHD. From individual to individual, one or more different comorbid symptoms e.g., anxiety, learning disorder, oppositional defiant disorder, conduct disorder, depression ; can exist. DIATHESIS-STRESS MODEL One of the models used in this review as a way of accounting for the different etiological variables of.
10 a ; In this study Witzel talks of a peaceful immigration but also uses the terms "battles" and "campaigns" 324 ; , "initial conquest" 326 ; and "frequent warfare" 339 ; thus indicating that beneath the lipservice to "migration" which became fashionable ; lurks the notion of invasion. The impression is supported by his use as an elite ; "dominance model" of the "Norman French introduced by a few knights and their followers in Anglo-Saxon England" 2001: 30, n 85 ; . He obviously does not know that the "few knights", most of them literate, unlike the IAs ; had in fact 12000 soldiers: led by William the Conqueror no peaceful immigration with such a title ; , they hewed down King Harold and his loyal thanes then proceeded to destroy villages in Southern England until London accepted William as their lawful king Trevelyan 1972: 106 ; . The example was used also in Witzel's 1997 work p xxii ; . b ; I can see why Witzel mentions C Ehret 2001: 12, 22 ; but Ehret's views, formed mostly from well documented cases in Africa are not relevant to prehistoric Saptasindhu and, in any case, I would like to see some real paradigms especially where Ehret says that the "linkage of pottery and ethnicity breaks down in class societies" 1988: 572 ; . The reference to Ehret is thus neither illuminating nor relevant. The quote from Anthony 1995 also vague and irrelevant ; cannot be traced in Witzel's Bibliography. Witzel's n177 20 on Archaeology ; says that recently some archaeologists "tested in Papua New Guinea what the material remains of some five different linguistic communities belonging to one particular area would look like". After a few years they dug them up "and found the same material culture! So much for the often used and alleged overlap of language and culture". In other words, archaeologists are useless and should leave all such investigations to linguists. But note that this esteemed Professor does not bother to specify who were the archaeologists, what was the area, who were the communities, what were these "material remains" and so on. Instead, on this vaguest of generalities he condemns the entire science of Archaeology. For similar views, see also n 21, below. ; That this superior attitude towards other scholars and scientists is customary is shown by a brief exchange between Prof Witzel and Dr Wujastyk Indology website, On Line 8 3 2000 ; . Wujastyk writes: "I afraid that I neither trust nor believe anything said by atomic scientists about humanistic subjects or most other subjects ; . Let's try to keep this list scholarly, shall we!" And Witzel agrees ! ; . Thus in this steam-roller statement scientists are considered incompetent or irrelevant for "most other subjects". To be scholarly is equated with indeterminate "humanistic subjects" and a supercilious attitude ? ; . It all rather extraordinary and androgel.

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1. Talk people through the process The more information people have, the better they're able to prepare for treatment. For example, many people are afraid of the biopsy procedure. A simple conversation about what a biopsy entails, and what their concerns are, can do a lot to allay fears. For side effects, let people know what to expect and what to look for. Talk about how you'll treat or manage side effects if and as they occur. Leave plenty of time for questions, and give people a way to get questions answered between appointments support groups, clinic educators, etc. ; . Offer additional educational material and resources. 2. Address mental health issues Many current and former drug users also have mental health diagnoses particularly depression and anxiety disorders. These conditions are treatable and should be assessed and managed before initiating hepatitis C treatment. Treatment poses its own risks to mental health, so people need close monitoring and proactive referrals to appropriate psychiatric care. Some clinicians initiate antidepressant therapy before beginning hepatitis C treatment, as a prophylactic measure for those at higher risk for developing symptoms of depression on treatment. 3. Support adherence Many current and former drug users can adhere to complex and difficult therapies the experience with HIV treatment has proven that. It's not always easy to predict who will have problems adhering to treatment. A simple way to gauge adherence is to assess whether people can consistently keep medical appointments. If someone's able to make 3 consecutive appointments, even if h she has to reschedule, then h she's more likely to be able to adhere to treatment. People who routinely miss medical appointments. Product development and finished product The development studies focused on four critical points: the active substance content uniformity, the development of a formulation, which could be filled in hard gelatin capsules, dissolution and stability of the finished product. Given the poor solubility and the low active dose of anagrelide, it was expected that finer particles were needed to faster dissolve and to more uniformly disperse in the formulation. For this reason micronisation has been performed and particle size specifications have been set. The justification of these specifications is based on retrospective data presented on 17 anagrelide batches. Commonly used excipients have been employed in the formulation. The compatibility between the active ingredient and the different excipients has not been investigated, but the stability studies indicate the suitability of the excipients in combination with the active ingredient. All batches used in the pivotal clinical studies have the same formulation as the product intended for the market. The manufacturing process is a standard wet granulation process followed by milling, blending and capsule filling and was chosen in order to improve the dissolution performance and the content uniformity results. In process controls are stated. Validation data from four full-scale batches and two full scale batches manufactured in the final premises have been presented. The validation concerned the drying, mixing and filling step as well as the encapsulation operating parameters. All batches met the acceptance criteria for the release of the final product and all pre-defined quality and performance specifications established in the approved validation protocol were met. Product specification The products specifications include tests by validated methods for appearance, identification HPLC ; , assay HPLC ; degradation products HPLC ; , average mass, uniformity of content Ph r. ; , dissolution and microbial purity. Batch analysis data from 35 production scale batches were presented. All batches met the test limits as defined in the release specification and test methodology valid at the time of batch release. The specification of the finished product complies with the requirements set in the current guidelines and batch analysis data confirm satisfactory uniformity. Stability of the product All stability studies were conducted in compliance with ICH requirements. The batches are tested for description, average capsule weight, assay, impurities and dissolution. Three validation batches were monitored up to 6 months under accelerated conditions 40 C 75 %RH ; and up to 5 years at 25 C RH. The first 4 production batches have also been monitored according to the ICH guidelines with up to 36 months long-term stability. Two additional batches are being monitored for up to 5 years under long-term conditions The stability data indicate that anagrelide capsules 0.5mg, packaged in the intended marketed pack HDPE bottles with desiccant, cotton coil and polypropylene cap ; maintained their physical integrity and potency and there were no significant changes in the dissolution results. As suggested by the results obtained from all batches, the proposed shelf life for the commercially packaged product under the conditions specified in the SPC is acceptable. Discussion on Quality aspects The development of Xagrid has been undertaken over a long period and the greatest part of it prior to Note for Guidance on Development Pharmaceutics. However all critical aspects have been studied and the quality of the product is adequately established. The active substance is stable; it is well characterised and documented. The excipents are commonly used in this kind of formulation and the packaging material is well documented. The manufacturing process of the finished product has been adequately described. Stability tests indicate that the product under ICH guidelines conditions is chemically stable for the proposed shelf life. However at the time and antabuse.

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METABOLIC COSTS DURING SPAWNING IN ZEBRA AND QUAGGA MUSSELS. A.M. Stoeckmann * and D.W. Garton. Perm State Univ., Worthington Scranton and Georgia Tech, Atlanta, amsl8 psu . Metabolic costs account for 90% of seasonal energy use by zebra mussels, thus processes that increase these costs, if at times of low energy reserves, may increase stress. To determine if metabolic costs differed between zebra and quagga mussels, we measured oxygen use 5 times every 3 wks with a Gilson Differential Respirometer from May - Aug. 1998. To determine how spawning influences metabolic costs, we induced spawning 4 times during that period using lmM Serotonin and measured oxygen use during gamete release. To examine how the intensity of spawning affects oxygen use, we weighed the'gametes released after collecting them on membrane filters. Oxygen use by zebra and quagga mussels did not differ over the season nor during spawning. Spawners used, on average, 34% more oxygen than did non-spawning mussels and oxygen use increased with spawning intensity. Thus, spawning significantly increases oxygen use and may be a stressful event for mussels.

Objectives: This study investigated whether treatment with beraprost sodium BPS ; , an orally active prostacyclin analog, improves hemodynamics and survival in patients with peripheralvessel chronic thromboembolic pulmonary hypertension CTEPH ; , for which there is no surgical option. Background: Oral administration of BPS has been shown to improve the hemodynamics and prognosis in patients with primary pulmonary hypertension; however, whether BPS has beneficial effects in CTEPH remains unknown. Methods: Forty-three patients with peripheral-vessel CTEPH were classified into two groups: patients treated with BPS BPS group, n 20 ; and those without BPS conventional group, n 23 ; . Baseline demographic and hemodynamic data did not significantly differ between the two groups. Results: BPS therapy improved New York Heart Association functional class in 10 patients 50% ; and significantly decreased total pulmonary resistance from 18 6 to Wood units p 0.05 ; [mean SD]. Sixteen patients died of cardiopulmonary causes in the conventional group during a mean follow-up period of 58 45 months. In contrast, only three patients died of cardiopulmonary causes in the BPS group during a mean follow-up period of 44 30 months. The absence of BPS therapy, elevated total pulmonary resistance, heart rate, and age were independently related to the mortality by Cox proportional hazard analysis. The 1-year, 3-year, and 5-year survival rates for the BPS group were 100%, 85%, and 76%, respectively, compared to 87%, 60%, and 46% in the conventional group. Conclusions: This preliminary study suggests that oral administration of BPS may improve hemodynamics and survival in patients with peripheral-vessel CTEPH, for which there is no surgical option. CHEST 2003; 123: 15831588 and antispasmodic.

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IMPLEMENTATION OF A PEER FEEDBACK SYSTEM Tara L. Hanuscak * , Amy L. Beatty, Charles F. McCluskey Riverside Methodist Hospital, 3535 Olentangy River Rd., Columbus, OH, 43214 thackett ohiohealth Purpose: Peer review reinforces accountability, teamwork and high quality performance standards. Results from past employee opinion surveys EOS ; indicated Riverside Methodist Hospital pharmacy department staff were interested in additional feedback on day to day performance. A system to facilitate anonymous collection and processing of constructive feedback from individuals working closely with one another needed to be developed. The peer feedback is intended to encourage peer accountability and individual growth; it will have no punitive effects. Methods: Initially a literature search was completed to locate articles related to peer feedback. Numerous brainstorming sessions occurred amongst the pharmacy leadership team to develop an optimal system design. The leadership team evaluated vendors to handle distribution, collection, data tabulation, and generation of the feedback reports. Focus groups were conducted within the department to identify the top ten skill sets to be addressed. Questions incorporating each of the ten skill sets were then written. The next phase of the project focused on organizing the department into work groups i.e. groups of individuals that work closely with one another ; . Individuals would evaluate and be evaluated by others within their work group. A standardized method for randomization within the group was developed, in addition to expectations regarding the peer review process i.e. distribution, deadlines for response etc. ; . Once the vendor was chosen, questions finalized, and work groups developed, usability testing occurred to identify potential deficiencies that needed addressed prior to implementation. Staff were actively involved in developing the system and regularly received communication throughout the process. Results Conclusions: To be presented at the conference. Learning Objectives: Evaluate strategies for successful implementation of a peer feedback system. Identify benefits and risks associated with a peer feedback system. Self Assessment Questions: T F Anonymity is a key component of a peer feedback system. T F Dropping the lowest scores helps maintain the integrity of the system.
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